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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Relationship between coronary artery and descending thoracic aortic calcification as detected by computed tomography:
Junichiro Takasu1, Matthew J Budoff, Kevin D O'Brien
1Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA 90502, USA.
Insights
Descending thoracic aortic calcification (DTAC) strongly predicts coronary artery calcification (CAC) independent of cardiovascular risk factors. This finding highlights DTAC
Area of Science:
- Cardiovascular imaging and diagnostics
- Atherosclerosis research
- Public health and epidemiology
Background:
- Cardiac computed tomography (CT) is crucial for detecting cardiovascular calcium, with coronary artery calcification (CAC) indicating coronary artery disease (CAD) and predicting cardiovascular (CV) events.
- Descending thoracic aortic calcification (DTAC) is prevalent in older adults and linked to increased CV risk, often associated with CAD and risk factors.
- Limited research exists on the combined prevalence and association of CAC and DTAC in large population-based cohorts using cardiac CT.
Purpose of the Study:
- To investigate the association between descending thoracic aortic calcification (DTAC) and coronary artery calcification (CAC) in a large, multi-ethnic, population-based cohort.
- To determine if DTAC is an independent predictor of CAC, beyond established cardiovascular risk factors.
- To explore potential differences in the association between DTAC and CAC based on sex.
Main Methods:
- Utilized data from the Multi-Ethnic Study of Atherosclerosis, including 6814 participants aged 45-84 from diverse ethnic backgrounds.
- Quantified both CAC and DTAC using non-enhanced cardiac CT scans.
- Employed multivariable relative risk regression to analyze the relationships between CAC, DTAC, and cardiovascular risk factors.
Main Results:
- 44% of participants had no detectable CAC or DTAC; 22% had both.
- DTAC was more prevalent in older individuals (mean age 71) compared to CAC (mean age 66).
- DTAC significantly predicted the presence of CAC independent of cardiovascular risk factors (PR: 1.17), with severity being a stronger predictor in women.
Conclusions:
- Descending thoracic aortic calcification (DTAC) is a significant predictor of coronary artery calcification (CAC), independent of traditional cardiovascular risk factors.
- The findings suggest DTAC may serve as a valuable imaging biomarker for identifying individuals at higher risk for coronary artery disease.
- Further research and follow-up of this cohort are warranted to confirm DTAC's role as an independent marker for future cardiovascular events.
Background:
Cardiac computed tomography (CT) is a well-established tool for the detection of cardiovascular calcium. Coronary artery calcification (CAC) is highly sensitive for the detection of coronary artery disease (CAD) as well as predictive of future cardiovascular (CV) events. Descending thoracic aortic calcification (DTAC) is common in the elderly and its presence is also associated with increased risk of CV events. Previous studies demonstrate that DTAC is associated with obstructive CAD and coronary risk factors. However, no prior studies have examined the association of CAC and DTAC as detected by cardiac CT in a large population-based cohort.
Methods:
In the Multi-Ethnic Study of Atherosclerosis, the study population included a population-based sample of four ethnic groups (Chinese, White, Hispanic and African-American) of 6814 women and men ages 45-84 years old. Participants underwent non-enhanced cardiac CT and both CAC and DTAC were quantified. DTAC was measured from the lower edge of the pulmonary artery bifurcation to the cardiac apex. Multivariable relative risk regression was used to evaluate relationships between CAC, DTAC and measured cardiovascular risk factors.
Results:
Overall 3030 (44%) did not demonstrate any detectable CAC or DTAC. A total of 1930 (28%) had only CAC, 386 (6%) had isolated DTAC, and 1464 (22%) participants were found to have both CAC and DTAC. CAC had a higher prevalence than DTAC in men (58% vs. 45%). Participants with DTAC were older than those with CAC (mean age was 71 and 66 years old, respectively). Participants with DTAC had increased risk for the presence of CAC independent of cardiovascular risk factors (prevalence ratio [PR]: 1.17, 95% CI: 1.07-1.28). Severity of DTAC was a stronger predictor of the presence of CAC in women as compared to men (PR: 1.04, 95% CI: 1.02-1.06, and PR: 0.99, 95% CI: 0.98-1.01, respectively).
Conclusions:
DTAC was found to be a strong predictor of CAC independent of CV risk factors. Ongoing follow-up of this cohort will evaluate whether DTAC is an independent marker of risk for CV events.
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